ISSN: 1449-1907International Journal of Medical Sciences
Global reach, higher impact
Int J Med Sci 2024; 21(4):656-663. doi:10.7150/ijms.92032 This issue Cite
Research Paper
Comparing the Long-Term Cardiovascular Outcomes of Lumbo-Peritoneal, Ventriculo-Peritoneal, or Non-Shunting Treatment after Idiopathic Normal Pressure Hydrocephalus: A Nationwide Retrospective Cohort Study
1. Spine Center, China Medical University Hospital, Taichung, Taiwan.
2. Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
3. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
4. Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
5. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
6. Department of Neurosurgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
7. Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
8. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
9. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
10. Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan.
11. Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan.
12. Artificial Intelligence Center for Medical Diagnosis, China Medical University, Taichung, Taiwan.
13. Department 0f Neurology, China Medical University Hospital, Taichung, Taiwan.
14. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
15. Department of Electrical Engineering, National Chung Hsing University, Taichung 40227, Taiwan.
16. Department of Electrical Engineering, National Chung Hsing University, Taichung, Taiwan.
Abstract
Purpose: With advances in medical technology, the average lifespan has increased, leading to a growing significance of idiopathic normal pressure hydrocephalus (iNPH), particularly in the elderly population. Most patients with iNPH have been treated either with ventriculo-peritoneal shunts (VPS) or conservative measures. However, lumbo-peritoneal shunts (LPS) have emerged as an alternative treatment option for iNPH in recent decades, extensive research still lacks comparing outcomes with LPS to those with VPS or non-surgical treatment. The aim of the resent study is to disclose the long-term therapeutic outcomes of LPS, VPS, and non-shunting in patients with iNPH.
Methods: We used the National Health Insurance Research Database in Taiwan to assess the long-term outcomes of these treatment options. We enrolled 5,537 iNPH patients who received shunting surgery, of which 5,254 were VPS and 283 were LPS. To compare the difference between each group, matching was conducted by propensity score matching using a 1:1 ratio based on LPS patients. Primary outcomes included death and major adverse cardiovascular events (MACEs)
Results: Our findings show that VPS resulted in significantly more MACEs than non-surgical treatment (Odds ratio: 1.83, 95% confidence interval: 1.16-2.90). In addition, both VPS and LPS groups had significantly lower overall mortality rates than non-shunting group. Moreover, LPS had lower overall mortality but similar MACEs rates to VPS.
Conclusions: Based on these findings, we propose that the LPS is preferable to the VPS, and surgical treatment should be considered the primary choice over conservative treatment unless contraindications are present.
Keywords: idiopathic normal pressure hydrocephalus, lumbo-peritoneal shunt, major adverse cardiovascular events, ventriculo-peritoneal shunt
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